Back pain is extremely common and costly both in terms of financial requirements and personally in terms of pain, suffering, loss of functional abilities and loss of the ability to work. While there are very large numbers of treatments for back pain available, few of them work well or work for any length of time and much of the management of our low back pain is up to ourselves. One of the important aspects of self maintenance is to keep up an exercise program of some kind, including aerobic or gym exercises, core stability work and range of motion for the lumbar spine.
Joint ranges of movement are not obvious to most of us but are vital to our ability to perform day to day activities. The shoulder is an important example of a highly functional joint which allows us to place our hands in front of our vision so we can perform precise actions. To do this it has a very large range of movement, allowing us to put our arms behind the back, behind the neck and right above the head. A joint can change due to illness or injury with various effects from loss of joint movement, looseness of the ligaments or damage to the joint surfaces themselves.
Injured joints go through the inflammatory process with a gradual formation of scar tissue over six weeks, the maturing scar beginning to contract around two to three weeks after injury. At this stage stretching and movement are important to maintain the length of the healing tissues and stimulate remodeling in these healing tissues closer towards the original type for the structure. Restriction of joint mobility can cause pain and limit everyday actions and functions we want to perform. If we lose movement in our shoulder or in our hand we have a problem as it gets in the way, but spinal loss of motion is less evident and we are more likely to accept it by default.
A back injury or back pain episode forces us to maintain the injured area as still as possible to impose minimal stresses on the damaged structures to reduce pain and further injury and inflammation. The pain then settles and the joints begin to move more normally again. Guarding of the damaged and painful area is often maintained beyond the necessary time for the state of healing of the joints, leading to a potential movement loss. Our spinal joints can easily compensate for loss of movement so a restriction is often not noticed but it can lead to changes in the way the lumbar spine functions or the risk of injury re-occurring.
Our tendency after an episode of low back pain injury and pain is to hold the injured joints still to reduce any stresses through them which might cause further injury or pain. This is reasonable in the immediate post-injury period to allow healing to progress and the joints to resume normal movement. A loss of movement can occur however if this guarding is maintained inadvertently beyond the time of the acute pain. This movement loss may not be noticeable as the back joints can compensate and we do not notice small reductions in movement but we can re-injure the stiff joint and it causes alterations in our back function.
Stiff joints cause alteration in muscle activation and joint movements, changing the way the complex interplay between muscle patterning and stability work in the spine. The coordinated weight bearing and movement functions of the spinal system are altered by the dysfunctional patterns of joint activity, leading to difficulties with pain and loss of function over time. If the joint stiffness remains there is a risk that the next time a movement is attempted the joint will be stretched to or beyond its stiff limit and could be re-injured. This is a good reason to try and loosen up these restrictions.
To have a fit back we need to take account of several aspects of what fitness means, including lack of pain, good range of movement, strength, endurance, stability and functional skill. Pain can be addressed by treatment from a physiotherapist or other therapy professional, stability can be learned from the same practitioners or a Pilates instructor and strength and endurance developed by a gym program. Once instructed, range of movement exercises can be regularly performed by us at home to maintain joint movement and counter any restrictions.
Joint ranges of movement are not obvious to most of us but are vital to our ability to perform day to day activities. The shoulder is an important example of a highly functional joint which allows us to place our hands in front of our vision so we can perform precise actions. To do this it has a very large range of movement, allowing us to put our arms behind the back, behind the neck and right above the head. A joint can change due to illness or injury with various effects from loss of joint movement, looseness of the ligaments or damage to the joint surfaces themselves.
Injured joints go through the inflammatory process with a gradual formation of scar tissue over six weeks, the maturing scar beginning to contract around two to three weeks after injury. At this stage stretching and movement are important to maintain the length of the healing tissues and stimulate remodeling in these healing tissues closer towards the original type for the structure. Restriction of joint mobility can cause pain and limit everyday actions and functions we want to perform. If we lose movement in our shoulder or in our hand we have a problem as it gets in the way, but spinal loss of motion is less evident and we are more likely to accept it by default.
A back injury or back pain episode forces us to maintain the injured area as still as possible to impose minimal stresses on the damaged structures to reduce pain and further injury and inflammation. The pain then settles and the joints begin to move more normally again. Guarding of the damaged and painful area is often maintained beyond the necessary time for the state of healing of the joints, leading to a potential movement loss. Our spinal joints can easily compensate for loss of movement so a restriction is often not noticed but it can lead to changes in the way the lumbar spine functions or the risk of injury re-occurring.
Our tendency after an episode of low back pain injury and pain is to hold the injured joints still to reduce any stresses through them which might cause further injury or pain. This is reasonable in the immediate post-injury period to allow healing to progress and the joints to resume normal movement. A loss of movement can occur however if this guarding is maintained inadvertently beyond the time of the acute pain. This movement loss may not be noticeable as the back joints can compensate and we do not notice small reductions in movement but we can re-injure the stiff joint and it causes alterations in our back function.
Stiff joints cause alteration in muscle activation and joint movements, changing the way the complex interplay between muscle patterning and stability work in the spine. The coordinated weight bearing and movement functions of the spinal system are altered by the dysfunctional patterns of joint activity, leading to difficulties with pain and loss of function over time. If the joint stiffness remains there is a risk that the next time a movement is attempted the joint will be stretched to or beyond its stiff limit and could be re-injured. This is a good reason to try and loosen up these restrictions.
To have a fit back we need to take account of several aspects of what fitness means, including lack of pain, good range of movement, strength, endurance, stability and functional skill. Pain can be addressed by treatment from a physiotherapist or other therapy professional, stability can be learned from the same practitioners or a Pilates instructor and strength and endurance developed by a gym program. Once instructed, range of movement exercises can be regularly performed by us at home to maintain joint movement and counter any restrictions.
About the Author:
Jonathan Blood Smyth is a Superintendent Physiotherapist at an NHS hospital in the South-West of the UK. He specialises in musculo-skeletal conditions and looking after joint replacements as well as managing chronic pain. Visit the website he edits if you are looking for physiotherapists in Leeds.
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